Anthem Prime (HMO-POS) Medicare Advantage Plan H4161-006 • 2027 • Fresno County, CA
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $3000.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $250.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Fresno County, CA
- Local Enrollment
- 1,468 beneficiaries in Fresno County
Anthem Prime (HMO-POS) Introduction
CMS Plan ID H4161-006 identifies Anthem Prime, a Medicare Advantage HMO-POS plan offered by Anthem Blue Cross Partnership Plan. The plan uses a Health Maintenance Organization with a Point of Service (HMO-POS) provider network and comes with prescription drug coverage. Its costs for the 2027 plan year include a $0.00 monthly premium, $0.00 medical deductible, and $3000.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $250.00.
Eligible Medicare beneficiaries residing in Fresno County, California can enroll in this plan. CMS reports local enrollment of 1,468 beneficiaries for this plan in Fresno County. New members can contact the plan at (833)668-2201 (TTY 711) for help and additional plan information.
Compare Similar Plans in Fresno County
Compare this plan with the two most-enrolled HMO-POS plans available in Fresno County, California. Enrollment is based on CMS local enrollment data.
| Plan Detail | Anthem Prime | AARP Medicare Advantage from UHC CA-0005 | Anthem Medicare Advantage |
|---|---|---|---|
| CMS Plan ID | H4161-006-0 |
H0543-035-0 |
H0544-056-0 |
| Local Enrollment | 1,468 | 1,130 | 533 |
| Monthly Premium | $0.00 | $65.00 | $0.00 |
| Medical Deductible | $0.00 | $0.00 | $0.00 |
| Maximum Out-of-Pocket | $3,000.00 | $7,150.00 | $3,000.00 |
| Part B Giveback | Not offered | Not offered | Not offered |
| Primary Care | $0 copay | $0 copay | $5 copay |
| Specialist | $0 copay | $0-$30 copay | $15 copay |
| Part D Deductible | $250.00 | $685.00 | $0.00 |
| CMS Star Rating | Not yet rated | Not yet rated | Not yet rated |
| Dental | $0 copay | $0 copay | $0 copay |
| Vision | $0 copay | $0 copay | $0 copay |
| Hearing | $0 copay | $0 copay | $0 copay |
Plan Benefits
Anthem Prime has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H4161-006.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H4161-006-0 Cost Compare.
Office Visits
- Primary care
- In-network: $0 copay
- Specialist
- In-network: $0 copay
Preventive and Wellness Services
- Annual wellness exam
- In-network: $0 copay
- Telehealth benefit
- In-network: $0 copay
- Routine chiropractic
- Not covered
- Fitness benefits
- Coming soon
- Health education
- Not covered
- Counseling services
- Not covered
- Over-the-counter drug benefits
- Not covered
- Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- In-network: $0-$210 copay
- Lab services
- In-network: $0-$10 copay
- Outpatient x-rays
- In-network: $0-$50 copay
- Diagnostic tests and procedures
- In-network: $0-$200 copay
Emergency and Urgent Care Services
- Emergency room care
- $150 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- $35 copay
- Inpatient hospital care
- In-network:
Tier 1
$225 per day for days 1-6
$0 per day for days 7-90
$0 per stay - Skilled Nursing Facility
- In-network:
Tier 1
$0 per day for days 1-20
$221 per day for days 21-100 - Ground ambulance
- In-network: $295 copay
Mental Health Services
- Outpatient individual therapy
- In-network: $40 copay
- Outpatient group therapy
- In-network: $40 copay
- Inpatient psychiatric hospital care
- In-network:
Tier 1
$225 per day for days 1-6
$0 per day for days 7-90
$0 per stay
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: $20 copay
- Occupational therapy
- In-network: $20 copay
Medical Equipment and Supplies
- Diabetes supplies
- In-network: $0 copay
- Durable medical equipment
- In-network: 20% coinsurance
- Prosthetics
- In-network: 20% coinsurance
Medicare Part B Drugs
- Chemotherapy
- In-network: 0%-20% coinsurance
- Other Part B drugs (Medicare-covered)
- In-network: 0%-20% coinsurance
Dental Services
- Oral exam
- In-network: $0 copay
Out-of-network: 20% coinsurance - Dental x-rays
- Not covered
- Cleaning
- In-network: $0 copay
Out-of-network: 20% coinsurance - Periodontics
- Not covered
- Endodontics
- Not covered
- Restorative services
- Not covered
- Implant services
- Not covered
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- Not covered
Vision Services
- Routine eye exam
- In-network: $0 copay
- Contact lenses
- In-network: $0 copay
- Eyeglass frames only
- In-network: $0 copay
- Eyeglass lenses only
- In-network: $0 copay
- Eyeglasses (frames & lenses)
- In-network: $0 copay
- Upgrades
- Not covered
Hearing Services
- Hearing exam
- In-network: $0 copay
- Fitting/evaluation
- In-network: $0 copay
- Prescription hearing aids
- In-network: $0 copay
You can choose for this plan to cover
either
your prescription or over-the-counter hearing aids each year, but
not
both. - OTC hearing aids
- In-network: $0 copay
You can choose for this plan to cover
either
your prescription or over-the-counter hearing aids each year, but
not
both.
Additional and Special Needs Services
- Adult day health services
- Not covered
- Home-based palliative care
- Not covered
- Personal emergency response system
- Coming soon
- Weight management programs
- Not covered
- Wigs for chemotherapy-related hair loss
- Coming soon
- Alternative therapies
- Not covered
- Massage therapy
- Not covered
- Home/bathroom safety devices
- Not covered
Certain preventive services are covered 100% by Anthem Prime as a Part B benefit.
Prescription Drug Coverage
Anthem Prime includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $0.00 |
| Supplemental Part D Premium: | $$0.00 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $7.28 |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $250.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Anthem Blue Cross Partnership Plan starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Anthem Prime may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $0.00 copay | Coming soon |
| Preferred Brand | 20% coinsurance | Coming soon |
| Non-Preferred Drug | 30% coinsurance | Coming soon |
| Specialty Tier | 30% coinsurance | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H4161)
The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (Part C) and Part D prescription drug plans each year using a 5-star system. These ratings measure plan performance in areas such as preventive care, management of chronic conditions, and member experience.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Contact Information for Anthem Blue Cross Partnership Plan
- Website
- Anthem Blue Cross Partnership Plan Plan Page
- Providers
- Anthem Blue Cross Partnership Plan Providers Page
- Formulary
- Anthem Blue Cross Partnership Plan Formulary Page
- Pharmacy
- Anthem Blue Cross Partnership Plan Pharmacy Page
- New Member Health Plan Help
- (833)668-2201
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (833)668-2202
- New Member Part D TTY Users
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | CMS Version |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | CY2027 Landscape (202609.1) |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | 2027 Star Ratings Data Tables |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | PBP Benefits-2027 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | 2026-09 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Anthem Blue Cross Partnership Plan (official source) | https://shop.anthem.com/medica | October 4, 2026 |
| Medicare.gov | Compare types of Medicare Advantage Plans | 25 May, 2025 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | 25 May, 2025 |
| Medicare.gov | Compare Original Medicare & Medicare Advantage | 25 May, 2025 |
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Page content independently curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for accurate, non-commercial Medicare plan interpretation and resolution.